“Working at HHS has been immensely rewarding, and I’m pleased with the progress that has been made in implementing the Affordable Care Act,” Angoff formally stated of his departure from HHS. “I look forward to returning to Mehri & Skalet to help make sure the law is enforced. The Affordable Care Act has given health insurance policyholders new rights, and will give them even more in 2014; it is critical that we defend those newfound rights.”

“We are thrilled to welcome Jay back to the firm as partner,” stated partner Cyrus Mehri, in a release Jan. 14. “Jay is a committed consumer advocate with a long history of success. We expect great things of our insurance and healthcare practice under his leadership.”

Angoff is going back to his plaintiff’s lawyer roots. Years ago, he obtained millions of dollars in refunds for insurance consumers. He was a principal drafter of Proposition 103 in California, the 1988 ballot initiative that rolled back auto insurance rates by 20 percent.

Sebelius appointed him to oversee the implementation of the PPACA insurance reform provisions in February 2010.

He is returning to Washington, D.C., after a stint heading the HHS regional office in Kansas City, Mo.

Before serving at HHS, Angoff was in private practice, first in Jefferson City, MO. and then in Washington with Mehri & Skalet, where he focused on obtaining refunds for individuals who were overcharged by insurance companies, his new (and old) law firm stated. Class actions in which Angoff served as a lead counsel include Landers v. Inter-insurance Exchange of the Automobile Club (Los Angeles County, $24 million settlement), Clutts v. Allstate (Madison County, Ill., $6 million settlement), and Foundation for Taxpayer and Consumer Rights v. GEICO (Los Angeles County, settled at up to $12 million).

“I think with his experience and knowledge related to the development of the regulations and the implementation of the ACA, insurers are going to have to stay on their toes as to how they treat their policyholders and consumers generally, and carry out their responsibilities,” said a Washington health insurance lobby representative.

The PPACA already imposes many new requirements and restrictions on health insurers and group health plans. Insurers can no longer impose lifetime benefits limits or, in most cases, rescind coverage. Group plan members with access to dependent benefits can keep children on their plans up to age 26. Another PPACA provision requires insurers to issue refunds if they spend more than 20 percent of individual or small group premiums on administrative expenses.

“While most insurance companies do obey the law, some don’t, and the remedies that insurance departments have and also that HHS has are often inadequate,” Angoff said today in an interview with National Underwriter Life & Health.

“HHS also doesn’t have that much enforcement activity with respect to the individual to order refunds to those who are injured if an insurance company does not obey the standards – that is why private enforcement is necessary,” Angoff stated.

HHS has the authority to impose civil penalties if it finds that a state is not enforcing the PPACA, but HHS does not have authority under the law to order refunds for consumers, Angoff said. For consumers, access to a regulator with civil penalty authority is not enough, he said.

The PPACA law is written in such a way that it doesn’t provide an adequate remedy for noncompliance — it does not have authority under the law to order refunds for consumers, Angoff said.

That’s where his new law firm will come in.

The PPACA law says that insurance companies can no longer impose lifetime limits or rescind coverage, as Angoff pointed out. The PPACA also enables young people to stay on their parents' policies until age 26; requiring insurers to issue refunds if they spend more than 20 percent of the premium dollar on administrative expenses and profit.

Take Missouri, he said. An insurance commissioner there, as Angoff once was, could impose civil penalties but not order an insurance company to give back refunds to the insurer. Missouri does not have authority to order refunds when a consumer in injured. Civil penalty authority is not an adequate remedy for consumers, Angoff said.

Angoff also once served as chair of the Missouri Commission on Health Insurance and as vice-chair of Missouri's Exchange for state workers. He was also deputy insurance commissioner in New Jersey, where he went to high school, and where he helped draft New Jersey's individual and small group reform laws.

States differ, of course, with New York, as he noted, being unusual in its power and willingness to order refunds for consumers.

But not every state is New York, thus the class action litigator. Founded in 2001 by Steven Skalet and Mehri, the firm is a national class action and complex litigation firm. The firm represents “employees, consumers, investors, small businesses and others in high-impact cases against powerful interests,” according to its website. It has settled cases involving Apple, Wachovia Securities and John Hancock, and it also has taken on the U.S. Department of Housing and Urban Development’s reverse-mortgage program.

There is a need, some see, for more comprehensive enforcement, or a smaller gap for consumers to fall between the cracks.

One group, the Georgetown University Center for Children and Families is recommending that the final version of the PPACA: Health Insurance Market Rules regulations be "much stronger in outlining the steps that will be taken to ensure proper and fair enforcement of the market reforms."

When HHS is deciding whether a state is enforcing the consumer rules, it should consider whether a state has adopted the legislation needed to implement the rules and whether the state is actually enforcing the rules, the Center said.

"In the absence of appropriate enforcement, there is a risk that the insurance reforms will prove illusory," the Center stated.

Cheryl Fish-Parcham wrote in the Families USA comment letter that her group wants to see HHS make states the primary enforcer of the rules, but to make it clear that HHS can step in if a state fails to enforce the rules.

"Having a clear line of authority will help to bring about timely resolution of problems," Fish-Parcham stated. "HHS and states should establish ongoing tools for monitoring abuse including well-publicized contact information for where consumers can report problems and the establishment of inter-agency work groups (including regulators and attorneys general) that will monitor problems and share information about both types of abuse and about specific abusive marketing schemes across states."

On a personal note, Angoff, a piano player, said he was glad to be back in Washington but said he believes Kansas City has more great piano players than any other place in the country. But, he added, the District has many free museums.